Pott's disease as the initial presentation of tuberculosis: diagnostic challenges and radiological findings in...

Spinal tuberculosis (Pott's disease) is a rare form of extra-pulmonary tuberculosis, often presenting with nonspecific symptoms and posing diagnostic challenges, especially in resource-limited settings. While microbiological confirmation is the gold standard, it is often unavailable in district hospitals.

I report the case of a previously healthy 28-year-old Black female individual who presented with a 3-week history of progressive lower back pain, fatigue, and functional impairment but without pulmonary symptoms or known tuberculosis contacts. Examination revealed a lumbar spinal bulge, localized kyphosis, and tenderness. Laboratory studies showed elevated inflammatory markers (C-reactive protein, 157 mg/L; white blood cell count, 11.2 × 10⁹/L). A lateral lumbar spine X-ray demonstrated a wedge-shaped compression fracture at L3 with focal kyphotic deformity and endplate irregularity. Microbiological confirmation was not possible at the district level owing to a lack of advanced diagnostics. After multidisciplinary consultation, empirical antituberculous therapy was initiated per national guidelines. Subsequent computed tomography at a tertiary center strongly supported tuberculous spondylodiscitis, and the patient has shown marked clinical improvement on conservative management.

This case illustrates the diagnostic complexity of spinal tuberculosis in district-level care and underscores the value of clinical suspicion, multidisciplinary collaboration, and careful assessment of plain radiographs when advanced diagnostics are unavailable. Clinicians should consider spinal tuberculosis in patients with chronic back pain and vertebral changes, even in the absence of classic tuberculosis symptoms. Early recognition and treatment are critical to prevent neurological compromise and deformity progression.